Cosmetic eye surgery

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As the only independent hospital in the region dedicated to eye care, Yorkshire Eye Hospital offers a full range of cosmetic eye surgery (oculoplastic surgery) options including:

• Eyelid surgery (blepharoplasty) to remove excess eyelid tissue
• Brow lifts
• The treatment of watery eye (epiphora)
• Droopy eyelids (ptosis)
• In-turning eyelids (entropion) and out-turning eyelids (ectropion)

If you are interested in cosmetic laser eye surgery so you won't have to wear glasses or contact lenses anymore, please visit our laser eye surgery page.

Blepharoplasty

What is blepharoplasty?

As we age, the delicate skin around the eyes can appear puffy or saggy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye bulge. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty. Blepharoplasty is a cosmetic eyelid surgery and can be performed on the upper eyelid, lower eyelid, or both.

The surgery is not only cosmetic and can be performed for functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and produce tired-feeling eyes. Most often, people choose eyelid surgery to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision, rather than for cosmetic reasons only, it may be covered by insurance.

Blepharoplasty for the lower lid removes the large bags under the eyes. It is unusual for third party payers to cover this as it is considered strictly a cosmetic eyelid surgery.

How is blepharoplasty performed?

This cosmetic eyelid surgery is usually performed on day care basis and can take one to three hours, depending on whether all four lids or just two (uppers / lowers) are done. Upper lid incisions are made in the natural crease of the lid, and lower lid incisions are made just below the lash line. A procedure for lower lid blepharoplasty, called transconjunctival blepharoplasty, removes excess fat through an incision inside the lower lid. Incisions are closed with fine sutures.

Swelling, bruising and blurry vision are common after blepharoplasty. Stitches are removed five to seven days after surgery, except in the cases where dissolving sutures are used.

Please feel free to contact us if you are interested in finding out more about cosmetic eyelid surgery at our hospital.

Brow lifts

The aim of this cosmetic eye surgery procedure is to rejuvenate the eyebrow and forehead area. It can reverse the gradual lowering of the brow due to ageing, in men and women. It can also help to correct the drooping brow in cases where the facial nerve has been damaged (e.g. in Bell's Palsy).

The operations aimed at restoring a more youthful appearance in terms of brow position and shape can be open (i.e. a cut to the skin area above the brow - external lift - or below the hairline - pre-trichial lift) or done via an endoscopic approach. This latter technique involves making small incisions (3 to 5mm) behind the hairline with the help of an endoscope (hence the name, endoscopic). The main advantage of this approach is the hidden scar.

The surgeon needs to take into account individual wants and needs of the patient to help decide which approach will achieve not just the best, but also a longer lasting result. During this cosmetic eye surgery, the muscles that cause frowning can be weakened but not completely as this can change the shape of the brow. It is also not uncommon for the surgeon to weaken the area with injections pre-operatively instead to reduce the risk of bruising.

The final technique of restoring the height of the brow is done along with a blepharoplasty. Here, excess skin (and fat) from the upper eyelid is removed surgically and the brow is then lifted internally. The amount of lift however will be more limited.

The open procedures and internal brow lift can be done with local anaesthetic and with or without sedation.

Watery eye (epiphora)

What causes a watery eye?

Normally, the lacrimal (tear) gland produces tears that keep the eye lubricated. These tears pass over the surface of the eye and drain away via a small "punctum" located on the upper and lower lid and then pass via a series of ducts into the nose.
A watery eye (epiphora) can have many different causes. Generally, this is from over production of tears or a problem with the drainage of tears away from the eye.

The ophthalmologist performs a careful clinical examination to determine the underlying cause of the watery eye. Anything irritating the eye has to be excluded as a cause of the watery eye, examples include in-growing lashes, infection and eyelid disease. Once these have been excluded as causes, then we know the problem should be with the drainage of the eye.

How do you diagnose a 'blockage' in the lacrimal system?

You will come to the ophthalmology department for an assessment. We will insert a dye (in drop form) into your eye to see if it drains away. The tear duct will then be flushed through with a saline solution via a blunt cannula to see if we find a blockage or not. If there is a blockage (which may be complete or partial) we can get an idea of its whereabouts during the syringing. Occasionally a dacryocystogram (a special form of X-ray examination of the tear drainage pathway) is required to assist in your assessment.
If a blockage is found then we may offer surgical intervention to help reduce the watering eye.

Can you treat my watery eye?

The answer in most cases is, yes. Treatment will depend on the cause. For example if the lower eyelid is sagging away from the eye and causing epiphora, the treatment will be cosmetic eyelid surgery designed to reposition the eyelid. It might be that you have a watery eye caused by a blockage to the drainage system of the eye. A blockage commonly develops from abnormalities in the lacrimal drainage system usually from scarring due to injury, recurrent infection, the ageing process, sinusitis or from unknown causes.

What are the surgical options available to me for a blocked tear system?

One option is intubation. Firstly, if there is a partial blockage of the lacrimal system we can simply insert silicon tubes into the tear ducts to try and keep the draining ducts open. This is the simplest and least invasive of the options and may be possible with you awake (i.e. under local anaesthetic). These tubes would stay in situ for a few months (usually two to three months) before we remove them. In doing this we are trying to restore the passages when the tubes are removed. These tubes are very fine and hardly noticeable with the naked eye. Also, they do not usually cause any significant discomfort. This simpler procedure has an overall success rate of about 65%.

How do you remove the silicone tubes from my tear ducts?

This a relatively simple procedure performed in the clinic. We snip the tubes from the outside and then get you to blow your nose. Normally, the tubes will be seen on blowing your nose. Sometimes the tubes will remain in the nose and we may have to find them with a small camera that we pass up your nostril. This can be performed in the clinic but may require a short day care procedure in the operating room.
On occasion the tubes may come out prematurely of their on accord. Should this occur, please do not be too alarmed. Simply ring the hospital and we will arrange to see you at the next suitable time to remove them for you.

Droopy eyelids - ptosis

Ptosis is drooping of the upper eyelid. This can be congenital or caused by the ageing process. The lid may droop only slightly or it may cover the pupil entirely. In some cases ptosis can restrict and even block normal vision. Congenital ptosis, or ptosis that is present at birth, requires treatment for normal visual development. Uncorrected congenital ptosis can cause amblyopia (lazy eye). If left untreated, amblyopia can lead to permanently poor vision.

How are droopy eyelids treated?

Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle that lifts the eyelid. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Children with ptosis, whether they have had surgery or not, should be examined annually by an ophthalmologist for amblyopia, refractive disorders, and associated conditions.

Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of ageing or involutional change, cataract or other eye surgery, an injury, or an eye tumour. Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes.

If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle, usually by shortening or resectioning. Often considered a purely cosmetic eyelid surgery, droopy eyelids can interfere with vision. Find out more by contacting us on 01274 612 566.

Entropion and ectropion

Normally, the eyelid is closely applied to the eye. This is important to allow tears to be effectively and comfortably spread across the eye with blinking. If the edge of the eyelid turns inwards the lashes will rub against the eye causing irritation, redness, and watering. An ulcer can occur if scratches on the eye become infected. In-turning of the lid is called entropion. If the eyelid falls away from the eye the edge of the lid can become red and stagnant tears collect causing infection and watering. This is called ectropion. Both conditions mainly affect the lower eyelids and are usually caused by an age-related loosening of the tissues of the lid.

Entropion and ectropion can be corrected with a simple eye surgery performed under local anaesthetic injection. The operation lasts about 30-40 minutes and you can go home the same day. Your surgeon will thoroughly assess your eyes and eyelids before surgery and tailor the operation to your individual condition. Potential complications such as bruising and infection will also be discussed prior to surgery.

Contact us for more information on the cosmetic eye surgery options available to you.